Healthcare Provider Details

I. General information

NPI: 1063896355
Provider Name (Legal Business Name): SHELLEY RORVICK MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY CAMPBELL-RORVICK

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W SUPERIOR ST SUITE 508
DULUTH MN
55802-5115
US

IV. Provider business mailing address

302 W SUPERIOR ST SUITE 508
DULUTH MN
55802-5115
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-7353
  • Fax:
Mailing address:
  • Phone: 218-409-6456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number16029
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1061-124
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2756
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: